“…On the other direction, it exists a “real world” aortic arch surgery made of emergent procedures, complex anatomy, lack of hybrid operative room, redo intervention, congenital conditions, and collagenopathies to deal with ( Carrel et al ) ( 4 , 5 ). In this context, Tirone-David expresses concerns that aortic arch replacement is not appropriate for the “general cardiac surgeon” ( 6 ).…”